Heading Frequency Is More Strongly Related to Cognitive Performance Than Unintentional Head Impacts in Amateur Soccer Players

Abstract

ObjectiveCompared to heading, unintentional head impacts (e.g., elbow to head, head to head, head to goalpost) in soccer are more strongly related to risk of moderate to very severe Central Nervous System (CNS) symptoms. But, most head impacts associated with CNS symptoms that occur in soccer are mild and are more strongly related to heading. We tested for a differential relation of heading and unintentional head impacts with neuropsychological (NP) test performance.MethodActive adult amateur soccer players were recruited in New York City and the surrounding areas for this repeated measures longitudinal study of individuals who were enrolled if they had 5+ years of soccer play and were active playing soccer 6+ months/year. All participants completed a baseline validated questionnaire (“HeadCount-2w”), reporting 2-week recall of soccer activity, heading and unintentional head impacts. In addition, participants also completed NP tests of verbal learning, verbal memory, psychomotor speed, attention, and working memory. Most participants also completed one or more identical follow-up protocols (i.e., HeadCount-2w and NP tests) at 3- to 6-month intervals over a 2-year period. Repeated measures General Estimating Equations (GEE) linear models were used to determine if variation in NP tests at each visit was related to variation in either heading or unintentional head impacts in the 2-week period before testing.Results308 players (78% male) completed 741 HeadCount-2w. Mean (median) heading/2-weeks was 50 (17) for men and 26 (7) for women. Heading was significantly associated with poorer performance on psychomotor speed (p < 0.001) and attention (p = 0.02) tasks and was borderline significant with poorer performance on the working memory (p = 0.06) task. Unintentional head impacts were not significantly associated with any NP test. Results did not differ after excluding 22 HeadCount-2w with reported concussive or borderline concussive symptoms.ConclusionPoorer NP test performance was consistently related to frequent heading during soccer practice and competition in the 2 weeks before testing. In contrast, unintentional head impacts incurred during soccer were not related to cognitive performance.

BDNF Val66Met Positive Players Demonstrate Diffusion Tensor Imaging Consistent With Impaired Myelination Associated With High Levels of Soccer Heading: Indication of a Potential Gene-Environment Interaction Mechanism

“…Participants: Soccer players enrolled in the Einstein Soccer Study from November 2013 through August 2018 were included in this analysis. Recruitment and study procedures are described in detail elsewhere (9,23,24). In brief, adult amateur soccer players in the New York City and surrounding areas were recruited via print, internet advertisement and through soccer leagues, clubs, and colleges.…”

MRI-defined White Matter Microstructural Alteration Associated with Soccer Heading Is More Extensive in Women than Men

“…As part of an ongoing longitudinal study of adult amateur soccer players, 78 women and 212 men were recruited from amateur and collegiate teams from 2013 to 2016 (2,4,22). Subjects were considered to be eligible for inclusion in the source sample if they had played soccer at the amateur level for more than 5 years, were aged 18-55 years, and had been actively playing soccer for at least 6 months per year.…”

Risk Factors for Chronic Traumatic Encephalopathy: A Proposed Framework

“…It is noteworthy that all of the soccer players were skilled headers, 2 as the long-term effects for soccer heading may depend on the duration, frequency, and intensity of heading. 26,[36][37][38] Each sport may indeed confer different risks for later-life neurologic disorders due to differences in exposure to RHI. Boxing is often accompanied by head impacts from forces like a hook punch, whereas the majority of football impacts result in linear forces to the brain.…”

“…61 Lipton et al further created self-report measures to estimate heading in soccer, known as the HeadCount or HeadCount-2w, which have predicted acute functional brain alterations in active soccer players. 36,38,62,63 Continued development and validation of RHI exposure measures across the different sports will greatly facilitate research on the short-and long-term neurologic effects of RHI. Exposure to RHI: The Importance of When Not all individuals exposed to RHI develop CTE and individual exposure differences may influence the pathological development of CTE.…”